neonatal hypothermia is a very emergency condition. if we identify this in early stage we can save the life of neonate. all should know about the maintaining the temperature if the neonate is in our home.

1. HYPOTHE
RMIA
Presented by
MR. ABHIJIT P. BHOYAR
M SC NURSING
CHILD HEALTH DEPARTMENT

2. INTRODUCTION
Hypothermia is considered as silent killer in
neonates.
It increases the neonatal morbidity and
mortality.
 Maintenance of warmth of the neonates
enhances their survival

3. CONTI..
Piere Budin (1900) first drew attention to the
high neonatal mortality due to cold.
 Optimum thermal environment for neonates
was identified in mid 1960s, as they are easily
influenced by the extremes of environmental
temperature.
Thermal protection of the newborn babies is
considered as one of important essential
neonatal care.

4. DEFINITION
Hypothermia is a common alteration of state of
the neonates. Neonatal hypotherrnia occurs
the body temperature drops below 36.50 in the
newborn infant (WHO). Normal body
temperature is 36. 50 to 37. 50 C.

5. STAGES OF NEONATAL
HYPOTHERMIA
The thermo-neutral state of the neonates is
considered within range of 36.5 to 37.5 C.
The stages of hypothermia are as follows:
SEVERE
HYPOTHERMIA
MODERATE
HYPOTHERMIA
COLD STRESS
HYPOTHERMIA

6. • When the body temperature of the newborn
baby is between 36 to 36.4 C (96.8-97.6F)
then the baby is under cold stress
A. Cold stress
• An infant with temperature of 32 to 35.9 C
(89.6-96.6 F) has moderate hypothermia,
which is a danger to the baby.
B. Moderate
hypothermia
• An infant with a temperature of below 320C
or 89.6 F is suffering from severe
hypothermia, which need urgent skilled care.
C. Severe
hypothermia

7. A skin temperature change is the
initial indicator of cold stress. A
decreased core temperature (rectal) is
a late warning sign indicating that the
neonate is already compromised.

8. FACTORS RESPONSIBLE FOR
NEONATAL HYPOTHERMIA
Awareness and attention, about the importance
for neonates, among health care providers.
Inappropriate care of the baby immediately after
birth by inadequate drying and wrapping.
Separation of baby from the mother.
Cold environment at the place of delivery and
baby care areas.

9. Change of temperature from womb to cooler
extrauterine environment.
Inadequate warming procedure before and
during transport of the baby.
Excessive heat loss by evaporation,
conduction, convection and radiation from
wet baby to the cold linen, cold room and
cold air.

10. Certain characteristics of neonates, i.e. large
body surface area per unit of body weight, large
head, developmental immaturity of heat
regulation center, poor insulation due to less
subcutaneous fat in LBW baby and reduced
brown adipose tissue ( BAT) as heat source.
high Risk neonate- lbw baby, birth asphyxia,
congenital malformations and mother having
anesthetic drugs.

11. PROCESS OF
THERMOREGULATION
Thermoregulation is maintained by the process of heat
production or gain and heat loss.
 The mechanism of heat production in neonates is
known as nonshivering thermogenesis (NST) and the
site of heat production is brown adipose tissue (BAT).
 When heat loss begins, thermoreceptors of
subcutenous tissue, spinal cord and hypothalamus are
stimulated and NST is triggered.

12. The noradrenaline released from sympathetic
nervous system which acts on brown fat and in
heat production.
In full-term neonates BAT accounts for 4
percent of total fat, which is less in LBW
infants,
BAT is located in the axillary, neck, interscapular
region, mediastinum, around kidney and
adrenal glands.
It helps in chemical thermogenesis

13.  The heat loss in neonates occur by evaporation,
conduction, convection and radiation.
 Heat loss by evaporation occurs immediately after
birth if the baby is not dried and not covered
adequately. If humidity of the room is less, then
evaporative heat loss increased from exposed areas.
 Neonate may loss heat by conduction, i.e. direct
contact with cooler object or surface (e.g. cold table,
mackintosh, towel, tray, hands, weighing scale, etc.).

14.  Heat loss by convection takes place, when the baby is
placed in the cooler air and air movement is present
there, (e.g. open window, fans).
 By radiation the infant loses heat to cooler object.
Colder the object and closer it is to the neonate, the
greater the loss of heat by radiation.

15. CLINICAL FEATURES
EARLY CLINICAL SIGNS
 Skin temperature of the neonate is below 36.50C
 Hands, feet, abdomen are cold to touch
 Weak sucking ability, weak cry and lethergy
 Blue hands and feet due to peripheral vasoconstriction.

16. LATE SIGNS
Late signs due to persistent hypothermia
Gradual fall of body temperature Slow,
shallow and irregular respiration
Slow heart rate
Lethargy and poor response

17.  Pale body with face and extremities of
bright red color
 Central cyanosis may present
 Edema and sclerema (localized
hardening of the tissue) may be present
 Weight loss.
 Consequence of Neonatal Hypothermia

18.  Neonatal hypothermia has a number of serious
consequences.
 It has both immediate and long-term effects.
 The effects are hypoxia (due to more oxygen
consumption),
 Hypoglycemia (due to increased metabolism),
 Metabolic acidosis (due to BAT hydrolysis),
 Respiratory distress,

19.  Neonatal sepsis,
 Neonatal jaundice,
 Sclerema,
 Pulmonary hemorrhage,
 Impaired cardiac function,
 Coagulopathy,
 Sudden infant death syndrome,
 Delayed growth and development,
 Mental retardation, etc.
Sudden infant death syndrome (SIDS) is the unexplained death,
usually during sleep, of a seemingly healthy baby less than a year
old.

20. CONCEPT OF "WARM CHAIN"
 The concept of warm chain was introduced to describe
a set of interlinked procedures to minimize the
likelihood of hypothermia in all neonates.
 The links of warm chain are
warmth at birth
place
warmth during
transportation
warmth at
hospital or home.

21. These should be maintained by the
following activities:
 A. Warm delivery room (more than 250C) which is free
from draught.
- Warm reception and resuscitation of all neonates

22. - Immediate drying and wrapping
DRYING
WRAPPING

23. Skin to skin contact
between the mother
and neonate
(kangaroo mother
care)
Putting in mother's
breast within
half an hour of
birth

24. - Appropriate clothing, and bedding and
covering head properly
- Mother and baby nursed together
(bedding in or rooming-in) in the delivery
room or in lying in ward

25. B. Warm and safe transportation.
C. Warmth in special neonatal care unit.
- Training of all health care provider who are involved
in birth and subsequent care of the neonate, especially
on prevention of hypothermia, for improvement of
awareness about the silent killer.

26. PREVENTION OF NEONATAL
HYPOTHERMIA
The following measures should be taken for neonatal
hypothermia
A) At the time of birth in delivery room
 Delivery room should be warm and free from draught.
 Immediate drying and wrapping of the neonate in layers
of soft cloths or prewarm towel.

27.  Ensuring that head is well-covered.
 Wet cloth to be changed immediately.
 Provision of extrawarmth by radiant warmer or room
heater or 200 W bulb, as available.
 Baby should be kept by skin to skin contact or by the
side of the mother so that mother's warmth will keep
the baby Warm

28.  Fans to be kept Off to prevent air be kept closed to
prevent draught.
 Room temperature to be maintain 28 + 2 degree C or
according to baby's weight and postnatal age.
 Baby bath should be postponed.
 Cleaning of blood and meconium should be done with
lukewarm water. Undue exposure of the baby should be
avoided during nursing procedures.

29.  Allowing breastfeeding with half an hour of birth or as
early as possible to provide warmth, nutrition and
protection.
 Continuous observation of thermal state and other vital
 Keep the baby in skin to skin contact with mother in
kangaroo method at least for one hour to rnaintain
temperature, facilitate breastfeeding and improve
mother-infant bonding.

30. B. During transportation
 Transportation is the potential weakness link Of warm
chain.
 Temperature maintenance during transport is an
important aspect of prevention of neonatal
hypothermia.
- Baby should be transferred after establishment of
thermal stability.
- Assess the baby's condition and temperature.
- Baby's hands and feet should be as warm as abdomen.

31. - Baby can be transferred in skin to skin contact with
mother in kangaroo method or mother can keep the
baby close to her chest.
- Baby should be wrapped in prewarmed cloth.
- Baby's head, and extremities should be covered
properly avoid undressing the baby unnecessarily.
- Baby can be transferred within thermocol box with
prewarmed linen, plastic bubble sheet or silver
swaddler.

32. Silver
Swaddler
Simple open transport trolley should be avoided to
transport the baby

33. C. At neonatal care unit
 When mother is sick and unable to take care of her baby
then neonates are kept in the neonatal care unit.
Precautions should be taken to prevent hypothermia
along with other essential care.
- Receiving the neonate in prewarmed cot.
- Covering the baby with adequate clothing including head
and extremities and avoiding undue exposure.

34. - Keeping the ambient atmospheric temperature warm
for baby's weight and age (28-32 deegree C).
- Maintaining humidity around 50 percent.
- Early feeding with breast milk.
- Avoiding dip bath during hospital stay, till the umbilical
cord has fallen off.
- Sponge bath can be given with warm water in warm
room quickly and gently then wrapping promptly.

35. - Monitoring baby's temperature 3 hourly, during initial
postnatal days considering axillary temperature is as
good as core temperature.
- Gradual rewarming of the baby if she or he is cold.
Using extra warming devices whenever needed like
radiant warmer, room heater, heated water filled
mattress, isolette or incubator. Avoiding direct use of
hot water bottles.
- Decrease heat loss by convection, conduction and
radiation.

36. D. At home
 Nurse should teach the mother and family members
about neonatal care at home especially for maintenance
of and breastfeeding.
 Warmth to be maintained by warm room (rooming-in),
skin to skin contact (kangarooing), adequate clothing,
exclusive breastfeeding, bathing with warm water in
warm room, oil massage and use of solar heat.

37.  Mother should be taught to assess the thermal state
by touch.
 The warm and pink feet of the baby indicate that the
baby is in thermal comfort. But when feet are cold
and abdomen is warm to touch, the baby is in cold
stress.
 In hypothermia both feet and abdomen are cold to
touch.

38. Assessment of Temperature in
Neonates
 Low reading thermometer should be used to measure
the neonate's body temperature. Same thermometer
should be used in an individual neonate at the same site.
 Auxiliary temperature is preferable as it is safe and It
reflects rectal temperature if taken properly.
 For Accurate results, the neonate’s arm should be
adducted with the thermometer bulb deep in the
auxiliary pit.

39.  Auxiliary temperature is as good as core temperature,
provided thermometer kept for 3 to 5 minutes. Normal
auxiliary temperatures ranges is 36.3 to 37.2 degree c.
 Skin temperature is measured bv thermistor (tele-
thermometer) taped to skin of abdomen.
 The normal skin temperature for full term babies is 36
to 36.5 degree C and in preterm babies 36.2 to 37.2
degree c.

40.  Rectal temperature is not recorded in neonates
for routine monitoring.
 It is used only for sick hypothermic newborns.
 Normal rectal temperature in neonates is 36.6 to
37.2 degree C.
 Rectal thermometer can be inserted with
precaution in backward and downward direction.
 The depth of insertion should be 3 cm for term
babies and 2 cm for preterm babies.

41.  Baby's temperature can be assessed with
reasonable precision by human touch.
 Touch the baby by dorsum of hand. When feet are
cold and abdomen is warm to touch, the baby is in
cold stress.
 In hypothermia both feet and abdomen are cold to
touch.
 Both feet and abdomen are warm; indicate baby is
in thermal comfort and normothermic.

42.  Abdominal temperature is representative of
the core temperature and reliable in the
diagnosis of hypothermia.

43. Management of Neonatal
Hypothermia
 A hypothermic neonate should be rewarmed as
quickly as possible.
 Rewarming procedure depends upon the severity
of hypothermia and available facilities

44. In moderate hypothermia
 In moderate hypothermia (32-35.9 degree C), the
neonate should be placed with mother in skin-to-skin
contact in a warm room and warm bed.
 Radiant warmer or incubator can be used if available.
 Rewarming should be continued till the temperature
reaches normal range.
 Monitor temperature every 15 to 30 minutes.

45. In severe hypothermia
 In severe hypothermia, rewarming should be done
with air heated incubator (air temperature 35-36
degree C) or manually operated radiant warmer or
thermostatically controlled heated mattress set at 37
to 38 degree C.
 When body temperature reaches 34 degree C, the
rewarming process should be slowed down.

46.  Room heater, or 200 W bulb or infrared bulb can also be
used.
 Monitor blood pressure, heart rate, temperature and blood
glucose level.
 Preventive measures to reduce heat losses from the
baby should be followed.
 IV infusion with 10% dextrose, oxygen therapy and
vitamin K injection (1 mg for term baby and 0.5 mg for
preterm baby) should be administered along with routine
and supportive care

47.  Preventive measures should be implemented
against neonatal hypothermia to reduce morbidity
and improved survival of newborn babies, which are
easier than the curative management and
rewarming for neonatal hypothermia.
 Good quality obstetrical and neonatal care services
and attention of concerned health care providers
are essential for prevention of this health hazards.

48.  The health worker and mother should have
knowledge and skill for assessment and
prevention of hypothermia with use of common
sense, which is more important than the
availability of expensive equipment to keep the
baby warm.